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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Plasma adiponectin in patients with acute myocardial infarction treated with percutaneous coronary intervention
Aleksandra Włudarczyk-Michalewska1, Maciej Kaźmierski, Tomasz Pawłowski
1Clinic Hospital no. 7, Medical University of Silesia, Silesian Medical Center, Katowice, Poland. aleksam@poczta.onet.pl
Insights
Bone marrow cell (BMC) administration after primary percutaneous coronary intervention (PCI) is safe and improves left ventricular ejection fraction. However, BMC treatment led to greater lumen loss within the stent area compared to standard PCI alone.
Area of Science:
- Cardiovascular Medicine
- Regenerative Medicine
- Interventional Cardiology
Background:
- Primary percutaneous intervention (PCI) for acute myocardial infarction (AMI) does not universally restore left ventricular (LV) function.
- Bone marrow mononuclear cells (BMC) offer a potential regenerative therapy for infarcted myocardium.
- The combined effect of intracoronary BMC administration and primary PCI requires investigation.
Purpose of the Study:
- To evaluate the angiographic outcomes of intracoronary BMC administration following successful primary PCI in patients with anterior myocardial infarction and LV dysfunction.
- To assess the safety and efficacy of BMC therapy in conjunction with standard reperfusion therapy.
Main Methods:
- A study group of 40 patients with LV ejection fraction < 40% received 20 ml BMC into the infarct-related artery (IRA) after primary PCI.
- A control group of 25 matched patients underwent primary PCI without BMC administration.
- Quantitative coronary angiography was performed at 6 months to assess IRA patency and lumen diameter changes.
Main Results:
- While both groups showed a decrease in reference and stent area diameters, the BMC group experienced a larger lumen loss within the stent area.
- No significant difference in lumen diameter loss was observed distally to the stent between the BMC and control groups.
- The BMC-treated group demonstrated a greater improvement in LV ejection fraction compared to the control group.
Conclusions:
- Intracoronary BMC administration following primary PCI is a safe procedure.
- BMC therapy may lead to increased in-stent lumen loss but shows potential for improved LV function recovery.
- Further research is warranted to optimize BMC delivery and assess long-term clinical outcomes.
Background:
Even up-to-date reperfusion therapy using primary percutaneous intervention (PCI) in acute myocardial infarction does not result in improvement of the left ventricular (LV) function in all patients. Cellular myoblasty, a novel method using mononuclear bone marrow cells (BMC), can be applied in the infarcted myocardium area to stimulate regeneration and to limit the organ damage. However, the impact of intracoronary BMC administration on the effect of PCI is not clear.
Aim:
To assess angiographic outcomes in patients with anterior myocardial infarction and LV dysfunction, undergoing intracoronary BMC administration after a successful primary PCI.
Methods:
The study group consisted of 40 patients (mean age 56.2 years) with LV ejection fraction below 40%, in whom 20 ml of BMC were administered to the infarct-related artery (IRA) distally to the occlusion. The control group comprised 25 age- and sex-matched patients with similar values of LV ejection fraction undergoing bare metal stenting of IRA without BMC administration. Quantitative coronary angiography was performed 6 months later to assess IRA patency.
Results:
The reference diameter of the stented artery decreased in the study group from 3.22 +/- 0.28 mm to 3.16 +/- 0.18 mm (p < 0.05) and in the control group from 3.22 +/- 0.31 mm to 3.15 +/- 0.28 mm (p < 0.082); also in the area of the implanted stent the diameter decreased from 3.57 +/- 0.21 mm to 2.96 +/- 0.79 mm in the study group vs. 3.48 +/- 0.22 mm to 3.01 +/- 0.35 mm in the control group. For lumen diameter measured 10 mm distally to the stent, the diameter loss was similar in both groups. In 6 patients from the BMC treated group and in 3 patients from the control group there was asymptomatic lumen reduction > 70% (NS).
Conclusion:
The results of our study show that BMC administration into IRA is safe. The degree of lumen loss in the stent area was larger in the BMC group than in the control group. There was no significant difference in the lumen change distally to the stent; the artery diameter loss in both groups was similar, and the improvement in LV ejection fraction was greater in the BMC-treated group.
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